Some Thoughts on Aging and PT
I started a new class this week about geriatrics and the process of aging. The opening chapter addresses the definition of aging and theories of why it occurs. It wasn't very exciting. I've read most of it before. The section on increasing life expectancy, on the other hand, made me stop and think. The text made two points. First, any increases in life expectancy will be small. Most of the causes of early deaths such as diseases, infections and life threatening injuries have been controlled. Second, instead of focusing on life expectancy we should be focusing on slowing the onset of morbidities and improving the quality of life of older individuals.
Once an individual survives into midlife it is likely that person will reach his or her life expectancy because most of the things that shorten life occur in the earlier years. The problems we face as therapists with the geriatric population generally aren't related to age so much as the co-morbidities that accompany the aging process. These can include problems arising from diabetes, HTN, debilitating arthritic pain, CVAs and vascular issues to name a few. Patients don't come to therapy because they are old. They come to therapy because a co-morbidity has impaired their functional status.
The text pointed out that as therapists our role is to help delay the onset of the co-morbidities. That would allow the elderly to have the same life expectancy but spend less of it in a state of debility. This assumes that eventually everyone will fall victim to some sort of illness or disease process resulting in some state of dependence and/or a lesser quality of life. It assumes that as therapists we can somehow cause our patients to make the necessary lifestyle changes to enable that to happen. It also assumes everyone has the same potential to prolong morbidity free aging.
I have a problem with all of that. No one, PT or otherwise, can make another person make the healthy lifestyle changes necessary for that to happen. Even then there is no guarantee something unforeseen such as cancer or a major trauma won't still occur. There is no strong evidence out there that specifically links any of the preventive strategies discussed in text with actually preventing morbidities. The best the book could do was anecdotal evidence. Granted an individual who has out of control DM or HTN is a stroke waiting to happen. That doesn't mean I can do anything definitive about it.
Many of my stroke patients have numerous other medical problems. These people already have the co-morbidities the text is talking about preventing. By the time I'm working with them it's a little late for prevention. I think that's generally true everywhere. The people with healthy lifestyles probably aren't going to need therapy for awhile. It's the ones with the co-morbidities that need us the most.
Therapy is about helping people overcome impairments no matter what age group they fall into. If by helping someone recover from a stroke I'm delaying a morbidity, great. The geriatric population is unique. Aging changes how the body responds to the challenges it is exposed to. Preventing debility and morbity is a wonderful goal, but it isn't the only focus of therapy. When an elderly patient comes to me for therapy my job is to provide that therapy taking into consideration the circumstances arising from the aging process. Some people are going to age better than others. Those differences are what impacts therapy. Certainly I can encourage lifestyle changes but I can't make them happen.
As I progress through this course, I hope to learn how aging affects the body and how those affects alter therapy. My caseload will include both "healthy" and "unhealthy" geriatric patients. I'm sure there will be more of the latter than the former. Those are the ones I want to know more about. This week's reading made me look at how I think about the aging process. Since I'm nearing 50 this is becoming more important to me. So, yes, I want to know about remaining healthy as I age. I also want to know how to better treat those who've aged in poorer health.